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Contract Number Brand Code Brand Name Active Ingredient Trade Name Package Size Formulary Category Pkg Price Unit Price Unit Description Max. Reimbursable Quantity / Month Package Description Manufacturer Code Manufacturer Name Agent Code Agent Name Benefit Therapeutic Code Therapeutic Desc Drug Contract Start Date Drug Contract End Date Status Description Default Route Max Repeats Therapeutic Head Amend Date
40 73512 VASTAREL MR 35MG TAB (SER/STO) TRIMETAZIDINE TRIMETAZIDINE VASTAREL MR 30'S C 16.61 0.55 TABLET 0 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 240404 ANTIARRHYTHMIC AGENTS 2022-04-06 2024-03-31 Package Size Change Oral 0 CARDIOVASCULAR DRUGS 2022-04-06
40 73516 TRIMETAZIDINE 20MG TAB (HEA/RXP) TRIMETAZIDINE TRIMETAZIDINE 10X10 A 9.79 0.10 TABLET 90 TAB HEA HEALTH 2000 INC RXP RX PRO INC 240404 ANTIARRHYTHMIC AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
40 7351F VASTAREL MR 35MG TAB (SER/COL) TRIMETAZIDINE TRIMETAZIDINE VASTAREL MR 30'S C 16.61 0.55 TABLET 0 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD 240404 ANTIARRHYTHMIC AGENTS 2022-04-13 2024-03-31 Add to Contract as Cat C Oral 0 CARDIOVASCULAR DRUGS 2022-04-13
40 7351K VASTAREL MR 35MG TAB (SER/COL) TRIMETAZIDINE TRIMETAZIDINE VASTAREL MR 60'S C 33.22 0.55 TABLET 0 TAB SER LES LABORATOIRES SERVIER COL COLLINS LTD 240404 ANTIARRHYTHMIC AGENTS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 7351K VASTAREL 35MG MR TAB (SER) TRIMETAZIDINE (C) TRIMETAZIDINE VASTAREL 60'S C 68.5 1.1417 TABMR 0 BOX SER LES LABORATOIRES SERVIER COL COLLINS LTD 240404 ANTIARRHYTHMIC AGENTS 2024-04-01 2026-03-31 ORAL 0 ANTIARRHYTHMIC AGENTS
42 7351K VASTAREL 35MG MR TAB (SER) TRIMETAZIDINE TRIMETAZIDINE VASTAREL 60'S C 68.50 1.14 TABMR 0 BLIS SER LES LABORATOIRES SERVIER COL AVENTA BARBADOS 240404 ANTIARRHYTHMIC AGENTS 2026-04-01 ORAL 0 ANTIARRHYTHMIC AGENTS
40 7351L VASTAREL MR 35MG TAB (SER/STO) TRIMETAZIDINE TRIMETAZIDINE VASTAREL MR 60'S C 33.22 0.55 TABLET 0 TAB SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 240404 ANTIARRHYTHMIC AGENTS 2022-04-01 2024-03-31 Oral 0 CARDIOVASCULAR DRUGS
41 7351L VASTAREL 35MG MR TAB (SER) TRIMETAZIDINE (C) TRIMETAZIDINE VASTAREL 60'S C 68.5 1.1417 TABMR 0 BOX SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 240404 ANTIARRHYTHMIC AGENTS 2024-04-01 2026-03-31 ORAL 0 ANTIARRHYTHMIC AGENTS
42 7351L VASTAREL 35MG MR TAB (SER) TRIMETAZIDINE TRIMETAZIDINE VASTAREL 60'S C 68.50 1.14 TABMR 0 BLIS SER LES LABORATOIRES SERVIER STO BRYDEN STOKES LTD 240404 ANTIARRHYTHMIC AGENTS 2026-04-01 ORAL 0 ANTIARRHYTHMIC AGENTS
40 7351M CARDIZINE 20MG TAB (AUR/AHI) TRIMETAZIDINE TRIMETAZIDINE CARDIZINE 60'S A 5.33 0.09 TABLET 90 TAB AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC 240404 ANTIARRHYTHMIC AGENTS 2022-04-01 2024-03-31 Oral 6 CARDIOVASCULAR DRUGS
41 7351M CARDIZINE 20MG TAB (AUR) TRIMETAZID TRIMETAZIDINE CARDIZINE 60'S A 6.39 0.1065 TAB 90 BOX AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC 240404 ANTIARRHYTHMIC AGENTS 2024-04-01 2024-07-17 ORAL 6 ANTIARRHYTHMIC AGENTS 2024-06-05
41 7351M CARDIZINE 20MG TAB (AUR) TRIMETAZID TRIMETAZIDINE CARDIZINE 60'S A 6.12 0.102 TAB 90 BOX AUR AUROCHEM LABORATORIES AHI ARMSTRONG HEALTHCARE INC 240404 ANTIARRHYTHMIC AGENTS 2024-11-11 2026-03-31 ORAL 6 ANTIARRHYTHMIC AGENTS 2024-11-11
40 7351Q TRIMETAZIDINE 20MG TAB (HEA/ATB) TRIMETAZIDINE TRIMETAZIDINE 10X10 A 9.79 0.0979 TABLET IMMED HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 240404 ANTIARRHYTHMIC AGENTS 2022-12-07 2024-03-31 Change Local Agent oral 6 ANTIARRHYTHMIC AGENTS 2022-11-25
42 7351V TRIMETAZIDINE 20MG TAB (HEA) TRIMETAZIDINE TRIMETAZIDINE 10X10 A 9.68 0.10 TAB 90 BLIS HEA HEALTH 2000 INC AHI ARMSTRONG HEALTHCARE INC 240404 ANTIARRHYTHMIC AGENTS 2026-04-01 Price Change ORAL 6 ANTIARRHYTHMIC AGENTS 2025-10-31
42 7351W TRIMETAZIDINE 20MG TAB (HEA) TRIMETAZIDINE TRIMETAZIDINE 10X10 A 9.68 0.10 TAB 90 BLIS HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE 240404 ANTIARRHYTHMIC AGENTS 2026-04-01 Add to Contract as Cat A ORAL 6 ANTIARRHYTHMIC AGENTS 2026-01-26
42 7351X TRIMETAZIDINE 20MG TAB (HEA) TRIMETAZIDINE TRIMETAZIDINE 10X10 A 9.68 0.10 TAB 90 HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 240404 ANTIARRHYTHMIC AGENTS 2026-04-01 Add to Contract as Cat A ORAL 6 ANTIARRHYTHMIC AGENTS 2026-02-27